Trends in US dermatology physician assistant density 2016 to 2023: A cross-sectional analysis
Authors: Joshua Burshtein, Danny Zakria, Milaan Shah, Lauren Miller, Darrell Rigel
Journal: Journal of the American Academy of Dermatology (2023)

To the Editor: There is a rising need for dermatology services in the United States. Despite the growing number of dermatologists, there remains a nonuniform geographic distribution.1Glazer A.M. Farberg A.S. Winkelmann R.R. Rigel D.S. Analysis of trends in geographic distribution and density of US dermatologists.JAMA Dermatol. 2017; 153: 322-325https://doi.org/10.1001/jamadermatol.2016.5411Crossref PubMed Scopus (82) Google Scholar Advanced practice providers, such as dermatology physician assistants (DPAs), have supplemented dermatologists to increase provider density and help mitigate the shortage of dermatologists.2Glazer A.M. Holyoak K. Cheever E. Rigel D.S. Analysis of US dermatology physician assistant density.J Am Acad Dermatol. 2017; 76: 1200-1202https://doi.org/10.1016/j.jaad.2017.02.018Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar Understanding the distribution of DPAs and trends of workforce density over time is an important component of understanding the issues related to adequate health care coverage. This study was designed to assess current density and trends of US DPAs vs a 2017 study.2Glazer A.M. Holyoak K. Cheever E. Rigel D.S. Analysis of US dermatology physician assistant density.J Am Acad Dermatol. 2017; 76: 1200-1202https://doi.org/10.1016/j.jaad.2017.02.018Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar Using accepted prior methodologies,2Glazer A.M. Holyoak K. Cheever E. Rigel D.S. Analysis of US dermatology physician assistant density.J Am Acad Dermatol. 2017; 76: 1200-1202https://doi.org/10.1016/j.jaad.2017.02.018Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar a cross-sectional analysis to determine number of practicing DPAs by US postal section codes (first 3 digits of zip code) in 2023 was performed using Society of Dermatology Physician Assistants (SDPA) membership data. DPAs were defined as PAs who identify as primarily providing dermatology services. More than 75% of US DPAs are members of SDPA.32022 Statistical Profile of Certified Physician Assistants: an annual report of the National Commission on Certification of Physician Assistants. National Commission on Certification of Physician Assistants, Inc.https://www.nccpa.net/wp-content/uploads/2023/04/2022-Statistical-Profile-of-Board-Certified-PAs.pdfDate accessed: July 31, 2023Google Scholar The US Census Bureau population data for section codes was utilized to calculate DPA density. A Gini coefficient was calculated to quantitate the degree of geographic inequality of US DPAs. In 2023, there were 3709 US SDPA DPAs. The US density of DPAs was 1.11/100,000. The 25 most DPA-dense locations in 2023 compared to 2016 are presented in Table I. The density of DPAs by section code is depicted in Fig 1. There were 252/880 (28.6%) section codes without at least one DPA. The Gini coefficient was 0.54.Table IChange in dermatology physician assistant density in the United States 2023 vs 2016202320162Glazer A.M. Holyoak K. Cheever E. Rigel D.S. Analysis of US dermatology physician assistant density.J Am Acad Dermatol. 2017; 76: 1200-1202https://doi.org/10.1016/j.jaad.2017.02.018Abstract Full Text Full Text PDF PubMed Scopus (13) Google ScholarRank3-digit postal codeLocationNo. of DPAsDPAs per 100,000 populationRank3-digit postal codeLocationNo. of DPAsDPAs per 100,000 population1102Manhattan, NY (Lower)213.31830Rock Springs, WY314.52214Annapolis, MD99.72022Boston, MA (downtown)27.13977Bend, OR145.43185Scranton, PA75.94379Knoxville, TN235.34214Annapolis, MD55.45837Boise, ID155.15507Waterloo, IA45.16185Scranton, PA65.06803Boulder, CO65.07831Rock Springs, WY24.57101Manhattan, NY (Upper East Side)34.88187Wilkes Barre, PA64.48502Des Moines, IA104.79813Durango, CO34.39253Charleston, WV54.310558Duluth, MN54.210998Juneau, AK24.011580Fargo, ND44.211915Burbank, CA43.712904Santa Monica, CA44.212571Sioux Falls, SD63.713222Arlington, VA104.213271Winston Salem, NC93.614216Eastern Shore, MD74.114685Lincoln, NE93.415804Denver, CO94.015288Asheville, NC43.316504Waterloo, IA43.916235Norfolk, VA83.317543Green Bay, WI73.717734Ardmore, OK33.218084Atlantic City, NJ23.718844Ogden, UT63.219288Asheville, NC53.719534Racine, WI43.120645St. Joseph, MO33.620837Boise, ID83.121125Mid-Hudson, NY163.621591Billings, MT43.122158Du Bois, PA33.422897Carson City, NV23.023662Kansas City, KS143.423260Wheeling, WV43.024493Grand Rapids, MI123.424181Allentown, PA53.025051White River Junction, VT13.425268Petersburg, WV13.0DPA, Dermatology physician assistant. Open table in a new tab DPA, Dermatology physician assistant. In 2016 there was a density of 0.78/100,000 US DPAs.2Glazer A.M. Holyoak K. Cheever E. Rigel D.S. Analysis of US dermatology physician assistant density.J Am Acad Dermatol. 2017; 76: 1200-1202https://doi.org/10.1016/j.jaad.2017.02.018Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar Our study found a 47% increase in US DPA density since then. This is consistent with another study finding DPAs increased by an annual average of 11.6% between 2013 and 2018.4Arnold J.D. Puckett K. Jeffery C. Kozikowski A. Evaluation of the dermatology physician assistant workforce in the US.JAMA Dermatol. 2022; 158: 693-695https://doi.org/10.1001/jamadermatol.2022.1026Crossref PubMed Scopus (5) Google Scholar Dermatologist density is higher in urban areas (the presence of large academic centers may contribute to this finding).1Glazer A.M. Farberg A.S. Winkelmann R.R. Rigel D.S. Analysis of trends in geographic distribution and density of US dermatologists.JAMA Dermatol. 2017; 153: 322-325https://doi.org/10.1001/jamadermatol.2016.5411Crossref PubMed Scopus (82) Google Scholar Although DPA concentration is also higher in urban areas,4Arnold J.D. Puckett K. Jeffery C. Kozikowski A. Evaluation of the dermatology physician assistant workforce in the US.JAMA Dermatol. 2022; 158: 693-695https://doi.org/10.1001/jamadermatol.2022.1026Crossref PubMed Scopus (5) Google Scholar DPA distribution has a more rural skew than that of dermatologists.1Glazer A.M. Farberg A.S. Winkelmann R.R. Rigel D.S. Analysis of trends in geographic distribution and density of US dermatologists.JAMA Dermatol. 2017; 153: 322-325https://doi.org/10.1001/jamadermatol.2016.5411Crossref PubMed Scopus (82) Google Scholar,2Glazer A.M. Holyoak K. Cheever E. Rigel D.S. Analysis of US dermatology physician assistant density.J Am Acad Dermatol. 2017; 76: 1200-1202https://doi.org/10.1016/j.jaad.2017.02.018Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar Previous literature has established the addition of DPAs to the workforce enhanced geographic coverage for dermatology services.5Glazer A.M. Rigel D.S. Analysis of trends in geographic distribution of US dermatology workforce density.JAMA Dermatol. 2017; 153: 472-473https://doi.org/10.1001/jamadermatol.2016.6032Crossref PubMed Scopus (65) Google Scholar While there are still regions without DPA presence, overall DPA density continues to rise [Fig 1].2Glazer A.M. Holyoak K. Cheever E. Rigel D.S. Analysis of US dermatology physician assistant density.J Am Acad Dermatol. 2017; 76: 1200-1202https://doi.org/10.1016/j.jaad.2017.02.018Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar However, the Gini coefficient suggests a high geographic nonuniformity of US DPAs remains. Limitations to this study include inability to present data for DPAs not in the SDPA database. The database also does not include dermatology nurse practitioners. Additionally, densities may be underestimated or overestimated as individuals may cross section code lines for treatment, and providers may practice across multiple sites. However, using the same methodology as prior published studies supports the validity of our findings. This study reveals DPA density and distribution in the United States is rising. However, there remains a nonuniform geographic distribution. The increased presence of DPAs found in this study versus 2016 may contribute to expanded access for patients who require dermatologic care. Despite this, geographic gaps in coverage persist and public policy initiatives may be needed to enhance uniform access to care. None disclosed. We thank the Society of Dermatology Physician Assistants for providing data for this study.